Vitiligo: How to treat skin depigmentation disease?

Vitiligo is a dermatological disease that causes depigmentation of the skin. It gradually removes pigment from several areas of the skin, causing them to become lighter. No area is favored or spared from the ravages. It can therefore reach the face, hands, feet, etc. without distinction. Physically, it is a painless disease. It is a benign pathology that can cause a lot of problems. However, those affected suffer psychologically, in particular because of the way others look and the stigma. The causes of this evil are still unclear and it remained for a long time without remedies. The good news is that new advances have been made in research to the point where different treatments exist today to overcome vitiligo. This article tells you all about this skin pathology.

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What is vitiligo?

To start, know that Vitiligo is a skin disease that is neither contagious nor infectious and without pain at least on the physical level.

Definition

The word vitiligo comes from the Latin “vitium” which means “vice, defect”. It is an autoimmune pathology. That is to say, it results from a dysfunction of the immune system which causes it to attack the normal components of the body. It particularly affects the melanocytes of the skin, responsible for pigmentation. In fact, white spots appear on the body without distinction of zone.

Also called "Leucoderma" or "achromia", vitiligo affects approximately 1 to 2% of the French population, i.e. approximately 600,000 and 1.2 million people. It usually affects children and adults under the age of 30. The disease usually manifests in the areas of the feet, hands, genitals, but other parts are not immune. The white spots that appear are considered strange and sometimes unsightly to the public opinion.

Overview of vitiligo

Achromia is manifested by the appearance of white spots on different areas of the skin. These spots are caused by the disappearance of melanocytes. Indeed, melanocytes are cells that produce melanin. It is this melanin that gives the skin a more or less dark color depending on its quantity and its degree of oxidation. This melanin also plays a protective role against the effects of the sun on the skin. The disappearance of melanocytes can have several causes that we will detail below.

It has long been mistakenly thought that vitiligo is a psychosomatic, psychological disease or that it was due to stress. Nevertheless, it has a serious impact on the quality of the patient's social life because of the disgrace it can cause. This impact on the psychological level has the same weight as that of cancer or depression.

The different forms of vitiligo

Vitiligo comes in different forms. There are a total of four forms of Vitiligo.

It is this form that affects children and adolescents much more. The spots are well demarcated and only appear on one side of the body. They take a few months to settle and do not evolve. The area of ​​the skin concerned is an area innervated through a particular nerve.

Generalized vitiligo is the form presented by 90% of sufferers. Unlike the first, it is scalable. It starts with the face, attacks the hands, feet and so on. The white spots appear in the areas of friction, including the armpits, the belt, etc. They appear in large numbers and small sizes.

Most often, the appearance of a new spot is announced by itching. This form can also cause discoloration in the hair and body hair: this is called leukotrichia.

It is the most serious and rare form of the disease. It is manifested by complete depigmentation of the skin.

In this form, the disease affects only the parts of the body with a mucous membrane. It affects the genitals, lips, etc.

What Causes Vitiligo?

It is difficult to pinpoint a precise origin for vitiligo. Researchers have made hypotheses to shed more light on the causes of this disease. The majority of them lean towards the theory that it is a multifactorial disease. Here are some factors that can cause vitiligo.

Autoimmunity

This is the most plausible hypothesis. Researchers have identified a correlation of approximately 15% to 20% of cases between this pathology and autoimmune diseases . These include thyroid problems, diabetes, rheumatoid arthritis, IBD (inflammatory bowel disease), etc.

This would mean that the body of people with vitiligo produces abnormal antibodies. The latter attack the autochthonous cells, more precisely the melanocytes. It is after these are destroyed that the skin turns white, due to lack of pigment production.

The genetic origin

It is not uncommon for several members of the same family to suffer from vitiligo. Scientists have identified 15 genes that are thought to be involved. However, carrying one of these genes does not make you a perfect candidate for the disease. The interactions that trigger the disease are still unclear.

Studies are underway to detect possible anomalies during the formation of the embryo. Researchers are looking for specifics that could explain the fragility of melanocytes in affected people.

The Nerve Involvement Theory

This theory is more oriented towards segmental vitiligo. As a reminder, the white spots appear on the path of a nerve. It is from this fact that the hypothesis was born according to which the end of certain nerves would produce enzymes which are toxic for cells such as melanocytes .

Free radicals

Several studies and analyzes have shown that the melanocytes of affected people abnormally accumulate free radicals. These are the waste products of oxidation which cause confusion in cellular functioning and thus the destruction of the cell. These free radicals can be produced during severe stress. This makes it an aggravating factor for the disease.

In this case, doctors prescribe oxidative food supplements to perform adjuvant treatment.

What are the risk factors for vitiligo?

Not everyone has the same degree of exposure to vitiligo. Some people, because of certain predispositions, are more exposed than others.

This is the case of people who suffer from another autoimmune disease. It is noticed that the majority of people with Vitiligo are already suffering from other autoimmune disorders like pernicious anemia, type 1 diabetes, lupus, etc. 30% of vitiligo patients have autoimmune problems of the thyroid gland (hyperthyroidism or hypothyroidism).

People with a family history of vitiligo are also more at risk than others. These cases represent approximately 30%.

Besides these two possibilities, there are many other factors that could cause or aggravate the disease. These include, among others:

Koebner's phenomenon is another risk factor for this disease. This is the gradual appearance of new lesions caused by old lesions such as scars, recent cuts or areas of friction.

What are the symptoms of Vitiligo?

The symptoms of vitiligo are easily recognizable. The skin of an affected person is bleached in places: this is called achromia. White spots like chalk appear and gradually evolve from one area to another. In the case of segmental vitiligo, the spots are limited to a given area. With mucosal vitiligo, they only reach the mucous membranes of the anatomy. While generalized vitiligo promotes expansion to other areas of the body.

Note that the contour that delimits the white spots is accentuated by a band of skin with a darker color than normal. Their size can range from a few millimeters to several centimeters. They are not painful, but the patient may feel itching or burning on the affected parts.

In addition, it is possible to notice early bleaching of body hair, eyebrows, beard or hair.

Possible course of the disease

It is difficult, if not impossible, to predict how vitiligo may progress in a patient. There is no known rule to predict the evolution of the spots, their number, their shape, etc. Generally, they evolve gradually from one area to another. Even if these cases are rare, it can happen that all the spots disappear naturally.

In reality, vitiligo is not such a serious disease in itself. However, it presents a rather serious risk of evolution. Since the skin is no longer protected against the ultraviolet rays of the sun, the patient is now exposed to the risk of developing skin cancer. Affected people are therefore obliged to use a sunscreen with a high protection factor.

How to treat vitiligo?

Vitiligo remained uncured for a long time. But recent advances in research have led to the discovery of a large number of remedies to overcome vitiligo.

Natural treatment for vitiligo

Natural vitiligo treatments allow patients to reduce depigmentation. To do this, they can use aloe vera and evening primrose oil. Both of these products are known for their restorative effects on the appearance of the skin. They make it possible to unify the complexion and to standardize the pigmentation.

In addition, doctors recommend that sufferers use sunscreen to avoid the devastating effects of the sun. The application of poultices of radish on the affected areas allows a regeneration of melanin.

On the other hand, you can use papaya. It is renowned for its melanocyte activating effects. To use it, you can make a poultice of it or extract its juice to drink. Apart from these adjuvant treatments, certain solutions are known for their curative effects if they are well used.

It is very adored by herbalists because of the brake it represents for the development of vitiligo. It promotes repigmentation when the patient consumes about 120 mg per day and orally.

Here, it is a mixture to be prepared. You need to add 5 teaspoons of turmeric to 250ml of mustard oil. Apply the mixture to the affected parts at least twice a day.

The leaves have virtues that improve the production of melanin for a resumption of pigmentation activity for the skin. For a more satisfying result, add lime juice to a few drops extracted from basil leaves. Apply the mixture to the white spots. Continue treatment for up to 5 or 6 months.

You can also use stingy seeds to facilitate the upsurge of melanin. To do this, you need to add stingy seeds to a few spoonfuls of vinegar. Mix everything until you get a paste that you will apply on the affected areas.

The Mama Cadela plant is very popular in traditional medicine to treat vitiligo. You can use extracts like boiled roots for at least 15 minutes. You just need to apply it every day on the affected parts for a return to normal pigmentation.

Local treatments for vitiligo

The main local treatments for this pathology are: topical corticosteroids and immunomodulators.

The most commonly used are topical corticosteroid creams. This treatment consists of premature treatment. It only applies to recent white spots. Its purpose is to reduce the action of the immune system and therefore stem the destruction of melanocytes. You have to apply corticosteroids once a day for months. When applying, avoid the eye area and mucous membranes.

This treatment can have side effects such as thinning and weakening of the skin. They appear after prolonged use of the cream. This is why the treatment must be done under the watchful supervision of a dermatologist.

Regarding immunomodulators, they are not yet used in France. In other countries, doctors use tacrolimus. Its action consists in neutralizing the T lymphocytes which are responsible for the immune response in the context of Vitiligo. Likewise, it helps in the repigmentation of parts exposed to the sun such as the face, hands, neck, etc.

Puvatherapy

This therapy consists of combining oral or local intake of psoralen and exposure to UVAs. Taking psoralen makes the skin receptive to the action of UVAs for 2 or 3 hours. This therapy is often applied in cases of generalized vitiligo when the spots cover at least 20% of the body surface. The patient should follow this treatment 2 or 3 times a week. But he will have to wait 2 to 3 months before noticing the effects.

It is a tedious therapy, as it requires up to 200 sessions with the dermatologist. Despite its effectiveness, only 20% of people treated recover total repigmentation. It may happen that subjects experience itching, burning, and manifestations of sunburn. This therapy is not indicated for pregnant women, breastfeeding women and children. It increases the risk of skin cancer.

The excimer laser

The Excimer laser provides monochromatic light at 308 nanometers. This light is an unparalleled source of UVB rays, which help to achieve good repigmentation. The rate of complete recovery is 70%.

This method is less tedious, because the number of sessions is reduced. The risk of exposure to skin cancer drops dramatically. Its side effects are very mild. It is often harmless erythema or mild itching.

UVBs

This therapy is newer and more promising than PUVA therapy. Here, UVB lamps have a narrow spectrum and do not need psoralen to work well. It is so advanced that it can be offered to children with generalized vitiligo. The success rate of repigmentation is very high. This therapy is less demanding, but it still requires 2 or 3 sessions per week with the dermatologist.

The melanocyte transplant

Beyond all the known treatments, the surgical option remains possible. This type of treatment consists of a transplant of valid melanocytes from the patient to the affected areas. This autologous transplant eliminates the risk of rejection and spares the patient from taking immunosuppressive drugs. In some cases, only the melanocytes are transplanted. In others, very thin pieces of epidermis taken from the unaffected parts are added.

The melanocyte transplant concerns cases of segmental vitiligo, not very extensive, which do not involve the Koebner phenomenon. It is used only when the patient does not respond to other treatments. Its results are not always impressive, because the new colorations obtained are not very homogeneous. In France, this intervention is not covered by health insurance.

The total depigmentation

This solution only concerns cases of vitiligo universalis. It consists of doing the opposite of what all the other treatments do, namely: depigmenting the areas that are still healthy. Thus the patient has a uniform skin color. This is a fairly drastic solution, which is not reversible and removes any possibility of future repigmentation.

The procedure consists of passing irritating products (based on hydroquinone) every day for about 1 year. It is important for the patient to know the side effects that he might face. These include burning, dryness, redness, etc. Rid of his melanocytes, he will always have to put on sunscreen to protect himself against the UVs of the sun.

How to prevent Vitiligo?

To date, there is no means of prevention against vitiligo. Nevertheless, people already affected must protect themselves from the sun by using sunscreens. This will allow them to avoid skin cancer.

Can you live with vitiligo?

Vitiligo is an almost painless disease on the physical level. The problem arises on the psychological plane. The questions, the mockery, the gaze of others are all psychological weights for the patient. The latter needs the help of those around him to get out of it. He can participate in support groups to better cope with the disease. He can also take herbal food supplements to try to keep a good mood. These different factors will help him overcome his greatest anxieties...

On the other hand, the person with vitiligo could also think about camouflage. The use of well-chosen and appropriate foundations will allow him to easily hide his spots. This solution is easier for people with segmental vitiligo. Everywhere today, dermatologists and beauticians give advice on techniques to perfectly camouflage your achromia. The most important thing is to choose the right products to avoid further problems. For children, it will suffice to choose clothing that covers them well.